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Published on: January 5, 2015
by Andrew Griffiths for The Telegraph:
Worried that forgetfulness might be an early sign of dementia? New research suggests there is no need to be anxious about an awkward memory lapse – as long as you can recall enough of the embarrassing detail to tell a friend about it.
Researchers at Sheffield Teaching Hospitals NHS Foundation Trust have found that how people talk about their memory problems is a vital clue to pinpointing their cause. They say a technique called Conversation Analysis (CA), used with patients experiencing memory lapses, can help distinguish between dementia and other problems.
Memory problems may be an early sign of organic disease such as dementia – but they may be also caused by other non organic factors, such as anxiety or depression. This is called functional memory disorder (FMD) and is unlikely to get worse, according to consultant neurologist Prof Markus Reuber, at Sheffield Teaching Hospital. Using the CA technique, his team of researchers have found that the way people talk about their memory problems is very different in those who have dementia, to those whose memory lapses have other causes.
Prof Reuber first used Conversational Analysis as a diagnostic tool in Germany with patients suffering from seizures. There, he found it was possible to distinguish between those suffering from epilepsy and those suffering from seizures caused by other factors simply by listening to them talk about symptoms. The success rate was 85 per cent.
In a pilot study, Prof Reuber and his team are now applying CA to patients referred by GPs to the specialist memory clinic at the Royal Hallamshire Hospital. The researchers have studied videos of more than 100 patients during their first consultation at the clinic, and searched for patterns in their initial conversation. Then they looked at whether those patterns were linked to whether or not the person was later diagnosed with dementia.
Prof Reuber describes the findings as ‘‘dramatic’’.
One clear difference which emerged between those diagnosed with dementia and those with FMD, was the way people responded when two or more questions were grouped together. ‘‘Ask a patient: ‘Where are you from originally and where did you go to college?’ and the person with dementia will not be able retain the information and answer both questions,’ he says. ‘‘The person who has memory problems due to other factors will be able to work their way through the questions.’’
Another clue was the use of the phrase ‘‘As I said…’’ or ‘‘Like I said…’’ which indicates a ‘‘working memory’’ during the conversation: patients with dementia did not tend to use these phrases.
When asked about the last time their memory failed them, those who had FMD could remember, and often constructed elaborate tales to illustrate the occasion. Those with dementia could not recall the details.
There are behavioural clues as well. Those who originally consulted their GP because they were concerned about their memory were less likely to have dementia than those who were encouraged to seek help by family members.
If a friend or family member was present in the interviews, those with dementia would often hesitate and turn to them for support when asked a question, while those with FMD did not seek this reassurance.
The Sheffield team hope that their Conversation Analysis technique will provide GPs and other primary care workers with an easily applied method to distinguish between those likely to be suffering from dementia and so best referred onto a specialist memory clinic, and those whose memory problems are due to other factors, which are best dealt with in the surgery.
”None of these differences on their own will be 100 per cent conclusive, but they are if you take them together, they could GPs a cumulative set of indicators,” says Paul Drew, Professor of Conversation Analysis at Loughborough University, who is working with Prof Reuber on the research.
Currently, only about half of patients referred to the Royal Hallamshire’s specialist memory clinic by GPs prove to have dementia and the evidence suggests this is probably typical of other memory clinics, which are under pressure because of the Government’s push to improve dementia diagnosis rates. The researchers hope that Conversational Analysis could reduce the number of unnecessary GP referrals to specialist memory clinics – while increasing the number of those most likely to have undiagnosed dementia.
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